BACKGROUND: Recovery of motor function after stroke may depend on a balance of activity in the neural network involving the affected and the unaffected motor cortices. OBJECTIVE: To assess whether transcranial direct current stimulation (tDCS) can increase the training-induced recovery of motor functions. METHODS: In an exploratory study, 14 patients with chronic stroke and mean Fugl-Meyer Upper Extremity Motor Assessment of 29 (range = 8-50) entered a double-blind sham-controlled study, aimed to investigate neurophysiological and behavioral effects of bihemispheric tDCS (cathodal stimulation of the unaffected motor cortex and anodal stimulation of the affected motor cortex), combined with constraint-induced movement therapy (CIMT). RESULTS: Patients in both groups demonstrated gains on primary outcome measures, that is, Jebsen Taylor Hand Function Test, Handgrip Strength, Motor Activity Log Scale, and Fugl-Meyer Motor Score. Gains were larger in the active tDCS group. Neurophysiological measurements showed a reduction in transcallosal inhibition from the intact to the affected hemisphere and increased corticospinal excitability in the affected hemisphere only in the active tDCS/CIMT group. Such neurophysiological changes correlated with the magnitude of the behavioral gains. Both groups showed a reduction in corticospinal excitability of the unaffected hemisphere. CONCLUSIONS:CIMT alone appears effective in modulating local excitability but not in removing the imbalance in transcallosal inhibition. Bihemispheric tDCS may achieve this goal and foster greater functional recovery.
RCT Entities:
BACKGROUND: Recovery of motor function after stroke may depend on a balance of activity in the neural network involving the affected and the unaffected motor cortices. OBJECTIVE: To assess whether transcranial direct current stimulation (tDCS) can increase the training-induced recovery of motor functions. METHODS: In an exploratory study, 14 patients with chronic stroke and mean Fugl-Meyer Upper Extremity Motor Assessment of 29 (range = 8-50) entered a double-blind sham-controlled study, aimed to investigate neurophysiological and behavioral effects of bihemispheric tDCS (cathodal stimulation of the unaffected motor cortex and anodal stimulation of the affected motor cortex), combined with constraint-induced movement therapy (CIMT). RESULTS:Patients in both groups demonstrated gains on primary outcome measures, that is, Jebsen Taylor Hand Function Test, Handgrip Strength, Motor Activity Log Scale, and Fugl-Meyer Motor Score. Gains were larger in the active tDCS group. Neurophysiological measurements showed a reduction in transcallosal inhibition from the intact to the affected hemisphere and increased corticospinal excitability in the affected hemisphere only in the active tDCS/CIMT group. Such neurophysiological changes correlated with the magnitude of the behavioral gains. Both groups showed a reduction in corticospinal excitability of the unaffected hemisphere. CONCLUSIONS:CIMT alone appears effective in modulating local excitability but not in removing the imbalance in transcallosal inhibition. Bihemispheric tDCS may achieve this goal and foster greater functional recovery.
Authors: David A Cunningham; Nicole Varnerin; Andre Machado; Corin Bonnett; Daniel Janini; Sarah Roelle; Kelsey Potter-Baker; Vishwanath Sankarasubramanian; Xiaofeng Wang; Guang Yue; Ela B Plow Journal: Restor Neurol Neurosci Date: 2015 Impact factor: 2.406
Authors: Giovanni Di Pino; Giovanni Pellegrino; Giovanni Assenza; Fioravante Capone; Florinda Ferreri; Domenico Formica; Federico Ranieri; Mario Tombini; Ulf Ziemann; John C Rothwell; Vincenzo Di Lazzaro Journal: Nat Rev Neurol Date: 2014-09-09 Impact factor: 42.937